What foods and drinks should a patient taking Lexapro (escitalopram) and Wellbutrin (bupropion) avoid?

Foods and Drinks to Avoid When Taking Lexapro and Wellbutrin

Patients taking Lexapro (escitalopram) and Wellbutrin (bupropion) should avoid grapefruit and grapefruit juice completely, limit alcohol consumption, and be cautious with tyramine-rich foods. 1, 2, 3

Key Dietary Restrictions

Must Avoid:

• Grapefruit and grapefruit juice:
  • Grapefruit inhibits cytochrome P450 enzymes (particularly CYP3A4) in the intestinal wall 1, 4
  • This can increase blood levels of medications, potentially leading to toxicity 5
  • For patients taking Lexapro, this interaction can increase drug concentration and side effects 2

Limit or Avoid:

• Alcohol:
  • Minimize or avoid alcohol consumption with both medications 3
  • Bupropion's FDA label specifically warns about rare reports of adverse neuropsychiatric events and reduced alcohol tolerance 3
  • Both medications can cause drowsiness, and alcohol may enhance this effect 2

Use Caution With:

• Tyramine-rich foods when taking these medications, especially if either is combined with an MAOI in the future:
  • Aged cheeses
  • Cured meats
  • Fermented foods
  • Certain beans
  • Some beers and wines
  • Soy products

Medication Interactions to Be Aware Of

Drug-Drug Interactions:

• Both medications can interact with MAO inhibitors, potentially causing serotonin syndrome 2, 3
• Bupropion inhibits CYP2D6, which can increase levels of other medications metabolized by this enzyme, including:
  • Antidepressants (venlafaxine, nortriptyline, imipramine, desipramine, paroxetine, fluoxetine, sertraline) 3, 6
  • Antipsychotics (haloperidol, risperidone, thioridazine) 3
  • Beta-blockers (metoprolol) 3, 6
  • Type 1C antiarrhythmics (propafenone, flecainide) 3

Herbal Supplements to Avoid:

• St. John's Wort: Can interact with both medications 1, 7
• Ma Huang (ephedra): May increase risk of seizures with bupropion 1
• Yohimbine: May increase blood pressure 1

Special Precautions

Seizure Risk:

• Bupropion lowers seizure threshold 8, 3
• Avoid other substances that may lower seizure threshold:
  • Excessive caffeine
  • Stimulants
  • Other medications that lower seizure threshold 3

Serotonin Syndrome Risk:

• Monitor for signs of serotonin syndrome when taking both medications:
  • High fever
  • Muscle rigidity
  • Rapid heart rate
  • Confusion
  • Loss of consciousness 2

Practical Recommendations

1. Completely eliminate grapefruit and grapefruit juice from your diet while taking these medications
2. Minimize alcohol consumption or avoid it completely
3. Consult with your healthcare provider before taking any new medications, including over-the-counter drugs and supplements
4. Be aware of potential drug interactions if you're taking other medications
5. Report any unusual symptoms to your healthcare provider immediately

By following these dietary restrictions and precautions, patients can help minimize potential adverse effects and maximize the benefits of their Lexapro and Wellbutrin therapy.